WHO Welcomes the New Nets Project

On October 5, 2018, the World Health Organization (WHO) published an information note welcoming the New Nets Project. The project is piloting new versions of insecticide-treated nets to provide a stronger line of defense against malaria-carrying mosquitoes resistant to existing insecticides.

WHO welcomes the launch of the New Nets Project by the Global Fund and Unitaid in September 2018. Under this new project, the 2 donors have joined forces to support the creation of the evidence base needed to inform the introduction of new types of insecticide-treated nets (ITNs).

In recent years, nets with two active ingredients (AIs) – a pyrethroid insecticide plus an unrelated active ingredient – have been developed to enhance the fight against malaria-carrying mosquitoes resistant to pyrethroids, the only insecticide class currently approved by WHO for use in ITNs. Whether these dual AI nets achieve their aim remains unknown. Evidence of “public health value” (i.e. epidemiological impact) for dual AI nets is keenly awaited to provide such confirmation and inform updated WHO policy recommendations.

The New Nets Project will close this knowledge gap by funding a series of randomized controlled trials (RCTs). Interceptor G2 and other dual AI ITNs will be compared to pyrethroid-only nets to determine if they have impact above and beyond the current standard of care. These studies, expected to take 2 to 3 years, will also investigate the potential correlation between entomological and epidemiological endpoints, which could enable changes to WHO’s data requirements for the evaluation of other types of new nets. This, in turn, could potentially reduce the time taken to generate the evidence needed to bring future ITNs to the market.

The New Nets Project goes beyond WHO’s priority need – generating data to inform a WHO policy recommendation – to support early scale up of the Interceptor G2, even before the RCTs are complete. This investment may provide early benefits for malaria control, if the RCTs confirm the public health value of the new nets. At worst, the investment will have provided the same level of vector control as pyrethroid-only nets, but at a higher price.

Interceptor G2 was evaluated under the former WHO Pesticide Evaluation Scheme (WHOPES). A human risk assessment, conducted as part of the evaluation, concluded that –when used as instructed – Interceptor G2 nets “do not pose undue hazards to people sleeping under them and/or washing them”.

During the transition from WHOPES to the new WHO evaluation process for vector control products, supported by the Prequalifications Team, the interim WHOPES recommendation of Interceptor G2 was converted to a prequalification listing, allowing for the procurement of this product by global health partners.